Category Archives: Health

Ambulance, Community Nursing, Health, NHS, Responding to media

Ambulance or Nurse?

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The Independant have an interesting story where, due to the shortage of ambulances the plan is to send community nurses first for patients over the age of 65 who have had a fall.

This is a bad idea.

But first, as a quick update on my career, I went from nursing into the ambulance service, and then returned to nursing. At the moment community nursing. So I’ve done both of the roles that the article is talking about.

The ambulance role is very much different from community nursing. When a community nurse sees a patient, it is not in an emergency situation. If you have a leg ulcer, or cancer, or a surgical wound that’s not healing as it should, then the community nurse is ideally placed to see to your needs. However if you have fallen and either can’t get up by yourself, or have broken your hip, then what you need is an ambulance.
This isn’t to say that comunity nurses don’t already keep people from going into hospital. Community Treatment Teams (CTTs as they are known in my patch, your acronym may vary) work hard to stop people with chroninc and acute conditions from needing to visit A&E. Unfortunately trauma is something entirely different to the heart failure, asthmatic and palliative patients that these teams see.
An ambulance crew are trained to deal with these acute traumatic incidents. Community nurses are not (as an aside there was some research about how nurses are really bad at first aid. And they are bad).

The plan is for a nurse to give a painkiller, including morphine, and then wait for the ambulance. At least I assume they are supposed to wait. I know I’m not going to give Doris with her fractured hip 10mg of morphine and then leave her on the floor. A big problem with this is that, as a community nurse, my day is already packed with patients (and as the government wants to kick more patients into the community, that will only increase). It is more common than not that I work through my lunchbreak, just in order to do the bare minimum for my patients. Community nurses do not have the time to play at ambulances.

What happens if the nurse overestimates the amount of morphine to give the patient, they’ll need a BVM, and training in how to use it and naloxone and how to give it, maybe some other drugs to counter potential bradycardia. And remember, a nurse doesn’t then have the option to load the patient into the back of an ambulance and whizz off to hospital. They’ve got to sit there.

And then who is going to supply the morphine, where will it be kept? Morphine is a Controlled Substance and needs to be kept in a special locked cupboard inside another locked cupboard. Who is going to provide a stock of morphine just in case it’s needed.

And then there is…

…but you get my point.

This is, yet again, an example of short-term thinking to patch up huge holes in the NHS that have been caused by successive governments. Both the ambulance services and the community nursing trusts need more money, and odd blue-sky thinking by people who are several steps removed from actually meeting patients is not the way.

Burning hatred, Health, NHS, Politics, Responding to media, TRUTH BASTARDS

Lord Warner – A Challenge

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Lord Warner has released a report stating that we should pay £10 ‘tax’ to use the NHS and that the NHS is ‘not cost effective’ despite all the evidence to the contrary. Both of these statements are frankly bollocks. However we have grown used to these lies and, as the media keeps pushing them, eventually they will be believed.

I looked up Lord Warner, he is the executive director along with a Suzanne Warner of ‘Sage Advice Ltd.’ A company that has no contact details, no website and no telephone number. At least none that I can find. This doesn’t mean that this ‘company’ is in any way dishonest, but as a simpleton in the ways of business I can’t see the reasoning behind it.

Of course, this, and Lord Warner’s previous job advising Apax Partners (a company that invests in private healthcare) might mean that he has some sort of vested interest in bringing about further privatisation of the NHS.

Sadly the newspapers only printed Lord Warner’s side of the story (i.e. Bullshit) and have not in any way highlighted these vested interests.

So, as I lay in bed trying to sleep but with sparking neurons of flaming anger keeping me awake I came up with an idea. It’s not a cunning idea, and Lord Warner would never agree to it, but it might be nice to dream.

You get a small, agile, hell – even amateur, filmmaker to stage an hour-long debate between Lord Warner and a defender of the NHS. They each have plenty time to prepare and can bring actual, real, evidence to defend their position – and this evidence is added to the debate, maybe even using whizzy computer graphics. Maybe there could be a referee who calls for the evidence to be brought out when one side or the other makes a statement and challenges the participants.

This film then goes up online where anyone can see it and we try to get newspapers (who really should be the people doing this sort of thing) to publicise it.

Every soundbite has to have evidence to back it up, there is no ‘playing to the crowd’, there is only truth.

Not that this sort of thing would ever be allowed – because Warner, (sorry, forgot the ‘Lord’ and tug of the forelock) already has all the power and this sort of truth finding would only have the risk of him seceding power to someone opposed to him. While the defender of the NHS has nothing to lose (except, y’know, the NHS) Lord Warner would have everything to lose by taking part in such a radical idea as a search for the actual real truth.

So, silly idea, but at least it gets this idea out of my head and onto the screen so that I can hopefully get some sleep.

Health, NHS

Kellett’s Laws Of Nursing

When I worked in the Urgent Care Centre I would often have student nurses spending their shift with me. Unfortunately for them I have many views and no shortage of desire to share these views with anyone within earshot. I’d also try to fit in some teaching if there was the time.

Over *mumble* years of nursing and ambulance work I formulated a few basics laws of nursing that I would inflict on as many students as I could catch. I never did get around to writing them down. Until now. 

Kellett’s Laws Of Nursing

1) Do Not Bullshit

If someone asks you to do something to a patient and you either do not understand or do not know how to do it then tell the person asking you. Do not under any circumstances ‘have a go’ and hope that it works out for the best. This is how you kill patients. For example if I send you to do an ECG (heart tracing) and you do it wrong I could end up sending them home without knowing that they are having a heart attack. I know it’s embarrassing to tell someone you don’t know how to do something – but it’s a damn sight more embarrassing to have to explain yourself to the coroner and the family of the patient you just killed. If you don’t know how to do something – don’t do it. Your biggest pressure is admitting a hole in your knowledge – and this ties in with my Fourth Law. This is how medical students were once trained – and look at how many people they kill.

2) It Hurts Them, Not You

Few people like to inflict pain on other people, but sometimes it has to be done. If I am sticking a needle in someone, it isn’t in the patient’s best interests for me to do this slowly and cautiously because I’m worried about hurting them because it will only hurt them more. What I often see is student nurses wincing before sticking a needle in someone as if they were about to inject themselves. Sometimes you just have to pull out that toenail despite the patient’s pain. (And yes, you can numb the toe – but that involves two injections into the base of the toe – and that really does hurt). What often doesn’t help the patient is if you are pulling faces, looking worried and being overly apologetic. Remember, it’s not going to hurt you – just do what needs to be done quickly and professionally and then get on to the next thing. Like wiping a bum, giving a suppository or examining someone’s genitals – it’s worse for them than it is for you.

3) Cynicism Kills Patients

I warn my students that they will either kill, or come close to killing, their first patient around two years after they have qualified. When they first qualify they are scared of doing the wrong thing, they will believe everything a patient says and will be exceptionally careful practitioners. Then their more qualified colleagues will start to corrupt them with their cynicism – ‘Oh he’s not in that much pain’, ‘She’s drug seeking’, ‘That’s not a heart attack, that’s attention seeking’. As we all like to fit into the social groups we find ourselves in, the new nurse will start emulating the more experienced nurse, specifically their cynicism. Unfortunately the new nurse does not have the experience of their colleagues* and so will dismiss a chest pain as ‘attention seeking’ and a patient will die. I like to err on the side of caution – if someone comes to me complaining of loads of pain and then skips out of the department after I’ve given them the good painkillers, then the only pain to me is my ego. Speaking of ego…

4) Leave Your Ego At The Door

Do you know what most complaints are to the NHS? ‘Attitude’. I’ve seen way to many staff get into an argument with a patient or relative because their ego will not let them back down. You do not need to ‘win’ your fights in order to do the right thing. For example – I have seen hundreds of patients who come to me in order to get antibiotics for viral illnesses. This is not only pointless but also downright dangerous. But most of them still leave the room smiling and happy despite my refusal to give them the antibiotics. I explain and if they argue I calmly explain again. I do not feel that I have to ‘win’, or prove that I am ‘smarter’ than them. The biggest obstacle in the way of calmly addressing a patient’s concerns is the nurse’s ego. My advice – the only way to win a primate hierarchy arguing game is simply not to play in the first place. I’ve been guilty of breaking this rule myself and it never ends well.

5) Anything You Do, Don’t Do, Or Do Badly, Can Kill Your Patient

It’s a summation of the above laws really but it does what it says on the tin. If you do something you might kill your patient. If you do something wrong you can kill a patient. If you do something badly… yep, you can kill your patient. So how do you stop from killing your patient? Simple – you pay attention, you do the best that you can for them, if you don’t know something then ask, if you are out of your depth then get help, and you keep learning and improving your knowledge. Treat each patient as if they were a beloved family member, or simply treat them how you would like to be treated. And if that doesn’t work then just imagine the Coroner or Judge staring at you over their glasses and asking your quite pointedly why you thought doing that was a good idea.

These may be a little tongue in cheek, and no doubt someone else has describe these elsewhere – but I think that you can avoid a lot of trouble if you just follow these laws.

Maybe I should expand these laws into a book ‘So, You Don’t Want To Kill Your Patient?’

*And age does not mean experience, as an ambulance driver will say you can have twenty years of experience, or you might have one year of experience repeated twenty times.

Health, NHS, Politics

Our New War

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The secretary of defence, Phillip Hammond, has stated that he will resist any further cuts to the armed forces. He said that the government’s priority was that they should be ‘defending the country and maintaining law and order’. He has said that the welfare should be cut by 0.5% in order to keep the armed forces at their current level.

The problem that I have with these statements is that ‘defence’ no longer means what it meant in the past. If you want to protect the people of Britain from death and injury then invasion from foreign powers comes pretty low down on the list of things we need to worry about.

Let’s take a look at the number of people who have died from ‘War’ in 2011 − 14 people.

The number of people who have died from infectious diseases is – 484,367 people.

By some coincidence the number of people who have also died from heart disease is – 484,367 people.

How about people who have died from just ischaemic heart disease? – 64, 435 people

How about the common type of age-related diabetes? – 1889 people.

Malnutrition killed 65 people in 2011.

Over four and a half times more people died of malnutrition than died in war. In a developed country.

(All numbers from the ONS – a fascinating read, although perhaps not recommended for hypochondriacs).

It is well known that poverty massively increases your chances of developing heart disease. Looking at a few studies, poverty pretty much doubles your chances of developing heart disease.

Poverty is one of the biggest influences on poor health, if you are a poor child then your risks of becoming chronically ill and dying young are greatly magnified.

Don’t take my word for it – google ‘poverty health outcomes uk’.

Our new war, from what we need more defence against, is disease. 

While I’m not going to argue that we disband the armed forces, our current threats are more terrorist than state-led. I doubt that the countries of the world are sitting around thinking ‘If only Britain didn’t have an army, we could roll in and conquer them completely’.  I’d suggest that if you look at the reasons given for the most recent UK terrorist attacks – it’s because we have soldiers in Afghanistan ‘protecting British interests’ by shooting at brown people that we have idiots blowing themselves up on public transport.

No, our biggest threat to life in the UK is disease the risk of which is increased by poverty. Poverty can be countered by welfare, which Mr. Hammond would like to see cut, and by the NHS, which is having it’s budget slashed while large parts of it are being sold off to private companies who want to make a profit from your sickness.

We need our ‘army’ to fight against what kills more people – disease, and by extension, poverty. At the moment the ‘slack’ in the system of dealing with disease is pretty much non-existent. Look at when one kebab shop was delivered contaminated meat – Seventy people became ill and made the local hospital declare an internal major incident. I know – I was there.

Now imagine what it will be like when the last antibiotics stop working, or when an influenza epidemic hits. We need to be investing now in order to save lives.

So instead of welfare and the NHS budget being cut so that soldiers can continue to war on the other side of the world, we need more effort to remove poverty from Britain and we need an NHS that will be able to cope with the incoming health crises that are likely  to be just around the corner.

Health, Politics

Conspiracy Theory

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The government closes the wards at a hospital and reduces funding so that the A&E four hour wait target is failed. The government then calls it a ‘failing hospital’ and sells it off to a private company. The government then gives the private company plenty of taxpayer’s money so that it can re-open the wards, reduce the waiting time and become a ‘succeeding hospital’.

The now succeeding hospital now turns a profit which goes into the pockets of the private comapany’s shareholders – who just happen to be members of the current government.

After all if it’s good enough for Gove to do to schools, it’s good enough for Hunt and Lansley to do to hospitals.

Ambulance, Health, Politics

It’s Not Rocket Science

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It is really quite simple – there aren’t enough ambulances to meet demand, why there aren’t takes a little more thought (but not much).

Take for example this story about a cyclist waiting two hours to go to hospital, and then needing a helicopter to pick them up.

A cyclist who broke his hip in an accident was forced to spend two hours lying on the roadside before being transported in the back of a furniture van flagged down by police because there were no ambulances available.

“I was there for a long time – two hours – and in a lot of pain because I have a low resting heartbeat which means I couldn’t be given morphine. It was raining and I was getting really cold and shivery.

“Eventually more paramedics arrived with blankets but I was still lying on the roadside and I was told I wasn’t even on the waiting list for an ambulance because there was a shortage.

“The paramedics were really kind and professional and caring but they were all saying this was ludicrous and down to budget cuts.”

In despair, the paramedics called for an air ambulance but were told the nearest one, in Essex, couldn’t take off because of high winds. A second helicopter from Norfolk was scrambled but couldn’t land in the road because of safety problems so had to touch down a mile away from Mr Knight.

“A policeman flagged down a passing furniture van driver and asked him to take me,” said Mr Knight.

Now add in the recent report showing that there just aren’t enough beds in hospital, and if there are enough beds then patients coming into the emergency department can’t be sent to the wards. This means the the emergency department gets full and they haven’t the room to take a patient off of an ambulance stretcher. This means the ambulance spends longer waiting and can’t turnaround for another call.

The number of people left waiting in ambulances outside accident and emergency (A&E) departments for more than half an hour has risen by over 100,000 in just two years, raising fears over the NHS’s ability to safely achieve the government’s aim of £20bn in efficiency savings.



Realise that ‘efficiency savings’ in real english is ‘cuts‘.

So, not enough beds means that ambulances have to wait longer to get clear of hospitals which results in increased waiting times for ambulances.The solution to this problem is apparently to close some emergency departments so that waiting times will get longer.

The results of a public consultation on the closure of four hospital accident and emergency units in north-west London have been released. The findings show support for ending services at Charing Cross, Central Middlesex, Hammersmith and Ealing.

I despair, I honestly do.

Health, Politics

Two Things

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I write this on the first day of the end of the NHS which comes despite the cries of pretty much every professional health-care body, a public petition that passed the ‘will be discussed in parliament’ (and then wasn’t), legal challenges to let us poor dumb voters know that a proper risk assessment was actually done and a general feeling that we are being screwed over.

I can list the ways in which the public of England have been screwed over, at some point in the future I’ll start talking about how we in Newham are already feeling the effects of the changes – and I don’t think it’s a spoiler to say that it’s not leading to better patient care.

While I am angry that all this is being done in the cause of ideology, and that the Liberal Democrats are playing the part of a puppy rolling over hoping for it’s belly to be scratched by Cameron, examining my feelings it is something else that is raising my blood pressure.

No, it’s frustration. It’s the feeling that no matter what we do, no matter how much we shout, no matter how many petitions, no matter how many MPs we write to that nothing will change. The government has it’s fingers in their ears shouting ‘Lalala – we can’t hear you’.

It’s the fact that the media would rather cover sports than the fate of the NHS. Take for example the recent peaceful protest where armed and riot police were in attendance kettling protestors. There was little to no coverage in the mainstream media about it.

This is the root of my anger – that there seems to be no way of fighting back against these unwanted changes.

I wish I were an organiser, I wish I have the knowledge and the skill to muster a group of people to help fight this. Instead I have two ideas – but no skill to make them happen.

First – the Risk register that the government is trying to hide should be published – and if this means a brave soul who has the register manages to leak it then so be it. Let it into the public domain so that it might be looked at fully by everyone – only then will I not believe that this whole act is driven by ideology.

Secondly – For every MP that voted for this bill I would have a group of smart and motivated people look into that person’s conduct. Expose every dodgy deal, all the MPs who have a stake in private medical companies, every campaign contribution. Not doing anything illegal – but showing every bit of corruption until finally it reaches a critical mass and there is no option but for that MP to resign (or be fired)*.

I’m one of those horribly idealistic people who thinks that if enough people see the truth then the world can change.

Stupid, I know, but it might be worth a try.

*And once we’ve done it to those who voted for the bill, we can do it to every other MP – might keep them a bit more honest…